Amnioinfusion for meconium-stained liquor in labour

  • Review
  • Intervention

Authors

  • G Justus Hofmeyr,

    Corresponding author
    1. University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa
    • G Justus Hofmeyr, Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, South Africa. justhof@gmail.com.

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  • Hairong Xu,

    1. Université de Montréal, Département d'Obstétrique-Gynécologie, Montréal, Province of Quebec, Canada
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  • Ahizechukwu C Eke

    1. Michigan State University School of Medicine/Sparrow Hospital, Department of Obstetrics and Gynecology, Lansing, Michigan, USA
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Abstract

Background

Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration.

Objectives

To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).

Selection criteria

Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid.

Data collection and analysis

Three review authors independently assessed eligibility and trial quality, and extracted data.

Main results

Fourteen studies of variable quality (4435 women) are included.

Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.

Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.

Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced.

Authors' conclusions

Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.

In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.

The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Plain language summary

Amnioinfusion for meconium-stained liquor in labour

Amnioinfusion is not beneficial for babies releasing medium to heavy meconium during labour, except in settings with limited facilities to monitor the baby's condition during labour.

A bowel movement (meconium) from the unborn baby during labour can enter the baby's lungs, causing breathing difficulties after birth. Extra liquid can be injected through the woman's vagina or abdomen into the womb (amnioinfusion) to provide more liquid to dilute the meconium and surround the baby. The review of 14 trials (4435 women) found that amnioinfusion with a salt (saline) solution is beneficial for babies only in settings in which babies are at high risk due to limited monitoring facilities. Further research into the effects on women is needed.

Laički sažetak

Ubrizgavanje dodatne tekućine (amnioinfuzija) u plodovu vodu tijekom porođaja kad je plodova voda onečišćena mekonijem

Amnionifuzija nije koristan postupak za novoročenčad koja su ispustila prvu stolicu (mekonij) u plodnu vodu tijekom porođaja, osim u situacijama kad ne postoji aparatura koja omogućuje praćenje djetetovog stanja tijekom porođaja.

Ukoliko dijete ispusti prvu stolicu (mekonij) tijekom porođaja u plodnu vodu, može ući u pluća te uzrokovati probleme s disanjem i smrt. Kroz rodnicu ili trbuh žene može se ubrizgati dodatna količina tekućine (amnioinfuzija) s ciljem razrjeđenja mekonija u plodovoj vodi. U ovom Cochrane sustavnom pregledu analizirano je 14 studija (4435 žena) te je utvrđeno da amnioinfuzija slane (fiziološke) otopine može biti korisna djeci jedino ako je dijete pod većim rizikom zbog manjka aparature za praćenje stanja djeteta. Za ispitati učinak amnioinfuzije na zdravlje žena potrebno je provesti dodatna istraživanja.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr